TEDMED 2014
Gail Reed: Where to train the world's doctors? Cuba.
蓋兒．瑞德: 世界醫生的搖籃在哪裡？古巴。
Filmed:
Readability: 5.1
824,908 views
解決非常問題需要非常手段，要靠偉大的理想、想像力和膽識激發。蓋兒．瑞德透過這場演講，告訴我們這樣一個值得注目的偉大手段：哈瓦那拉丁美洲醫學院，它是栽培優秀世界醫生的搖籃，造福全球各地迫切需要醫生的窮鄉僻壤。
Gail Reed - Cuban health care expert
American journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own. Full bio
American journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own. Full bio
Double-click the English transcript below to play the video.
00:12
I want to tell you
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我要告訴大家，
00:14
how 20,000 remarkable young people
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為什麼 2 萬個傑出的年輕人，
來自 100 多個國家，
00:18
from over 100 countries
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00:20
ended up in Cuba
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當初會選擇去古巴，
00:22
and are transforming health in their communities.
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而現在正在改善他們的社區衛生。
00:26
Ninety percent of them would never
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九成的這些年輕人
本來永遠不會離開家鄉，
本來永遠不會離開家鄉，
00:28
have left home at all
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00:29
if it weren't for a scholarship
to study medicine in Cuba
to study medicine in Cuba
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要不是獲得獎學金去古巴學醫，
00:33
and a commitment to go back
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而且立志回到那些
00:35
to places like the ones they'd come from —
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像他們生長背景的地方服務：
00:38
remote farmlands, mountains, ghettos —
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偏遠的農村、山區和貧民區。
成為醫生，
00:42
to become doctors for people like themselves,
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服務跟自己一樣的弱勢，
00:45
to walk the walk.
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用行動實踐信念。
00:47
Havana's Latin American Medical School:
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哈瓦那拉丁美洲醫學院
00:50
It's the largest medical school in the world,
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是世界上最大的醫學院，
從 2005 年第一班畢業，
至今已有 2 萬 3 千名畢業生，
至今已有 2 萬 3 千名畢業生，
00:53
graduating 23,000 young doctors
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00:56
since its first class of 2005,
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還有大約 1 萬名在學。
00:59
with nearly 10,000 more in the pipeline.
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01:02
Its mission, to train physicians for the people
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學校的宗旨是：
為最需要醫生的人培訓醫生，
01:06
who need them the most:
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01:08
the over one billion
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為世界上 10 多億從沒看過醫生的人。
01:10
who have never seen a doctor,
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01:12
the people who live and die
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這些人從出生到死亡，
01:16
under every poverty line ever invented.
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一輩子生活在各種貧窮線水平之下。
01:20
Its students defy all norms.
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這所醫學院的學生很特殊，
01:22
They're the school's biggest risk
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他們是學校最大的風險，
01:24
and also its best bet.
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也是最大的勝算，
01:26
They're recruited from the poorest,
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他們從世界上最窮的地區被招收進來。
01:29
most broken places on our planet
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學校相信
01:32
by a school that believes they can become
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他們不單可以成為好醫生，
01:34
not just the good
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01:35
but the excellent physicians
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而且是他們社群迫切需要的卓越醫生。
01:37
their communities desperately need,
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01:40
that they will practice where most doctors don't,
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他們也願意去多數醫生不去的地方，
01:44
in places not only poor
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這些地方不但貧窮，
甚至通常很危險。
01:46
but oftentimes dangerous,
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醫療包裡要帶蛇毒解毒劑，
01:49
carrying venom antidotes in their backpacks
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01:52
or navigating neighborhoods
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或是四處出診，
遊走在被毒品、黑幫、子彈摧殘得
千瘡百孔的地區，
千瘡百孔的地區，
01:54
riddled by drugs, gangs and bullets,
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就是他們的家園。
01:58
their home ground.
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02:00
The hope is that they will help
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培訓的目的
是要透過這些醫生，
就近提供社區醫療照護，
就近提供社區醫療照護，
02:02
transform access to care,
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02:04
the health picture in impoverished areas,
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提升貧窮地區的衛生水準，
02:07
and even the way medicine itself
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甚至顛覆醫學訓練和行醫的方式；
02:09
is learned and practiced,
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這些醫生會成為醫療先鋒，
02:11
and that they will become pioneers in our global reach
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將衛生保健推到世界每一個角落，
02:16
for universal health coverage,
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任務真的非常艱鉅。
02:18
surely a tall order.
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02:21
Two big storms and this notion of "walk the walk"
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兩個大暴風，
和「用行動實踐信念」的想法，
和「用行動實踐信念」的想法，
02:25
prompted creation of ELAM back in 1998.
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催生了哈瓦那拉丁美洲醫學院，
在 1998 創校。
02:29
The Hurricanes Georges and Mitch
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喬治和米奇兩個颶風
02:32
had ripped through the Caribbean
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重襲加勒比海和中美洲，
02:34
and Central America,
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02:36
leaving 30,000 dead
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造成 3 萬人死亡，
02:38
and two and a half million homeless.
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250 萬人無家可歸。
02:41
Hundreds of Cuban doctors
volunteered for disaster response,
volunteered for disaster response,
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數以百計的古巴醫生自願去救災，
不過他們一到那裡，
02:45
but when they got there,
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02:47
they found a bigger disaster:
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卻發現更大的災難：
02:49
whole communities with no healthcare,
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很多社區完全沒有醫療服務，
02:52
doors bolted shut on rural hospitals
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偏鄉的醫院都關閉了。
02:54
for lack of staff,
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因為人手短缺。
02:56
and just too many babies dying
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有太多太多的嬰兒不到周歲就夭折。
02:59
before their first birthday.
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03:02
What would happen when these Cuban doctors left?
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這群古巴醫生離開以後，
又會變成什麼樣呢？
又會變成什麼樣呢？
必須有醫生接手，繼續提供醫療，
03:06
New doctors were needed to make care sustainable,
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03:08
but where would they come from?
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但要去哪裡找醫生？怎麼訓練？
03:10
Where would they train?
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03:12
In Havana, the campus of a former naval academy
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後來，一所哈瓦那海事學院的舊校園，
03:17
was turned over to the Cuban Health Ministry
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由古巴衛生部接管，
03:20
to become the Latin American Medical School,
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改建成了拉丁美洲醫學院，
03:23
ELAM.
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也就是 ELAM。
03:25
Tuition, room and board, and a small stipend
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它提供學費、食宿，和小額生活津貼，
03:28
were offered to hundreds of students
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給數百名來自受災最重國家的學生。
03:30
from the countries hardest hit by the storms.
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03:33
As a journalist in Havana,
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我在哈瓦那當記者，
03:35
I watched the first 97 Nicaraguans arrive
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看著首批 97 位尼加拉瓜學生
03:38
in March 1999,
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在 1999 年 3 月來報到，
03:40
settling into dorms barely refurbished
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搬進了幾乎未整修的學校宿舍，
03:43
and helping their professors not
only sweep out the classrooms
only sweep out the classrooms
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幫教授們一下清空教室、
03:46
but move in the desks and the
chairs and the microscopes.
chairs and the microscopes.
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一下又搬進課桌椅和顯微鏡。
03:51
Over the next few years,
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接下來的幾年，
03:53
governments throughout the Americas
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美洲各國的政府
03:55
requested scholarships for their own students,
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都來幫自己的學生申請獎學金。
03:58
and the Congressional Black Caucus
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美國國會黑人同盟
04:00
asked for and received hundreds of scholarships
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也申請並且獲得數百個獎學金名額，
04:03
for young people from the USA.
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提供給美國的年輕人。
04:07
Today, among the 23,000
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至今 2 萬 3 千名校友，
總共來自 83 個國家，
04:10
are graduates from 83 countries
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遍佈美洲、非洲和亞洲，
04:13
in the Americas, Africa and Asia,
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04:16
and enrollment has grown to 123 nations.
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新生的國籍也增加到 123 個國家，
半數以上是年輕的女性，
04:22
More than half the students are young women.
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04:24
They come from 100 ethnic groups,
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來自 100 個不同種族，
04:26
speak 50 different languages.
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說 50 種不同的語言，
04:28
WHO Director Margaret Chan said,
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WHO 總幹事陳馮富珍說過：
04:31
"For once, if you are poor, female,
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「終於，如果你是窮人、
女性、
或是原住民，
04:35
or from an indigenous population,
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04:37
you have a distinct advantage,
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這些條件反而變成獨特的優勢，
04:39
an ethic that makes this medical school unique."
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這種價值觀使 ELAM 與眾不同。」
04:43
Luther Castillo comes from San Pedro de Tocamacho
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魯瑟．卡斯第羅來自
托卡馬喬市的聖佩德羅，
托卡馬喬市的聖佩德羅，
04:48
on the Atlantic coast of Honduras.
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位在洪都拉斯的大西洋岸。
04:50
There's no running water,
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這個村落沒有自來水、
04:52
no electricity there,
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沒有電力，
04:54
and to reach the village, you have to walk for hours
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從鎮上到那裡還得走好幾個鐘頭，
或跟我一樣，碰運氣搭小貨車，
04:58
or take your chances in a pickup truck like I did
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05:01
skirting the waves of the Atlantic.
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沿大西洋岸，趁著退潮行駛。
05:04
Luther was one of 40 Tocamacho children
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魯瑟
是托市 40 個上過小學的孩子之一，
05:09
who started grammar school,
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加利福納黑人原住民兒童，
05:11
the sons and daughters of a black indigenous people
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05:13
known as the Garífuna,
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05:15
20 percent of the Honduran population.
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這些原住民佔宏都拉斯兩成人口。
05:19
The nearest healthcare was fatal miles away.
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離他們最近的醫院
在好幾哩外，緊急時根本救命不及。
魯瑟每天得要走上 3 個小時，
05:24
Luther had to walk three hours every day
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05:27
to middle school.
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才能到中學上課，
05:29
Only 17 made that trip.
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只有 17 個小孩能上中學，
05:31
Only five went on to high school,
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只有 5 個繼續唸高中，
05:33
and only one to university:
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只有 1 個最後上了大學：
05:36
Luther, to ELAM,
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魯瑟來到了 ELAM 醫學院！
05:38
among the first crop of Garífuna graduates.
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成為第一批加利福納畢業生。
05:42
Just two Garífuna doctors had preceded them
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整個宏都拉斯歷史，
之前只曾有過 2 個加利福納族醫生，
之前只曾有過 2 個加利福納族醫生，
05:45
in all of Honduran history.
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現在有 69 個！
05:48
Now there are 69, thanks to ELAM.
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多虧有 ELAM 醫學院。
05:53
Big problems need big solutions,
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非常問題需要非常手段，
05:57
sparked by big ideas, imagination and audacity,
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靠偉大的理想、想像力和膽識激發，
06:00
but also solutions that work.
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但手段也必須行得通。
06:03
ELAM's faculty had no handy evidence base
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ELAM 沒有實證可行的現成課程，
06:07
to guide them, so they learned the hard way,
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所以大家必須辛苦地摸索學習，
06:10
by doing and correcting course as they went.
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邊學邊做，邊調整。
06:14
Even the brightest students
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這些貧窮地區，就算是最聰明的學生，
06:16
from these poor communities
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也沒能力立刻開始 6 年醫學訓練。
06:18
weren't academically prepared
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06:20
for six years of medical training,
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所以學校設計了科學銜接課程，
06:23
so a bridging course was set up in sciences.
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再上語言課。
06:26
Then came language:
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06:28
these were Mapuche, Quechuas, Guaraní, Garífuna,
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學生來自馬普切族、克丘亞族、
瓜拉尼族、加里福納族
瓜拉尼族、加里福納族
多為原住民，
06:31
indigenous peoples
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學過西班牙語，成為第二語言；
06:33
who learned Spanish as a second language,
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06:35
or Haitians who spoke Creole.
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也有說克里奧爾語的海地學生。
06:38
So Spanish became part
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所以西班牙文成為
上醫學先修課程之前的先修課程。
06:40
of the pre-pre-med curriculum.
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06:44
Even so, in Cuba,
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即使如此，
在古巴，
06:47
the music, the food, the smells,
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音樂、食物、氣味等等，
06:50
just about everything was different,
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一切風情民俗都截然不同，
06:53
so faculty became family, ELAM home.
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所以全校師生都變成一家人：
「ELAM 之家」
「ELAM 之家」
06:58
Religions ranged from indigenous beliefs
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宗教信仰多元：跨原住民信仰、
07:00
to Yoruba, Muslim and Christian evangelical.
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約魯巴信仰、穆斯林信仰、
基督教福音教派，
基督教福音教派，
07:05
Embracing diversity became a way of life.
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擁抱多元成為生活的方式。
07:09
Why have so many countries
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為什麼會有這麼多國家的人
07:11
asked for these scholarships?
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爭取這些獎學金呢？
07:13
First, they just don't have enough doctors,
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第一：他們的國家沒有足夠的醫生，
07:17
and where they do, their distribution
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就算夠醫生，
也分佈不均，漠視窮鄉僻壤。
07:18
is skewed against the poor,
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07:21
because our global health crisis
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因為全球的衛生醫療危機，
07:23
is fed by a crisis in human resources.
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是受人力資源短缺危機所致，
07:26
We are short four to seven million health workers
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光是基本醫療需求，
就缺少 4 到 7 百萬名醫療人員，
就缺少 4 到 7 百萬名醫療人員，
07:30
just to meet basic needs,
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世界各地都有這個問題。
07:33
and the problem is everywhere.
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07:35
Doctors are concentrated in the cities,
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醫生都集中在都市，
07:37
where only half the world's people live,
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而都市只占全球人口的半數。
07:40
and within cities,
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而且醫生都集中在市內，
07:41
not in the shantytowns or South L.A.
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不在週邊的貧民區或南洛杉磯。
07:46
Here in the United States,
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在美國，
我們雖然有健保改革，
07:47
where we have healthcare reform,
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卻短缺醫療專業人員。
07:50
we don't have the professionals we need.
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到 2020 年，
07:52
By 2020, we will be short
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會少 4 萬 5 千名基層醫療醫師。
07:55
45,000 primary care physicians.
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07:59
And we're also part of the problem.
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我們也是造成問題的元凶之一：
08:01
The United States is the number one importer
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美國是吸引全世界最多
發展中國家醫師的國家，
發展中國家醫師的國家，
08:04
of doctors from developing countries.
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第二個學生們搶進古巴的理由，
08:08
The second reasons students flock to Cuba
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08:11
is the island's own health report card,
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是這個小島本身的衛生水準，
08:13
relying on strong primary care.
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基層醫療做得很好。
08:16
A commission from The Lancet
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醫學權威《The Lancet》期刊的委員會
08:18
rates Cuba among the best performing
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把古巴列為全球醫療衛生
最佳的中收入國家之一。
最佳的中收入國家之一。
08:20
middle-income countries in health.
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「救助兒童會」評選古巴為
08:23
Save the Children ranks Cuba
174
491839
1946
08:25
the best country in Latin
America to become a mother.
America to become a mother.
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最適合生小孩的拉丁美洲國家。
08:30
Cuba has similar life expectancy
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古巴人的平均壽命跟美國人一樣長，
08:33
and lower infant mortality than the United States,
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嬰兒死亡率比美國低，
08:36
with fewer disparities,
178
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2181
且差距較少；
但是古巴花在醫療衛生的人均消費，
08:38
while spending per person
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1800
卻只有美國人的 1 / 20。
08:40
one 20th of what we do on health
180
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3015
08:43
here in the USA.
181
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2149
08:45
Academically, ELAM is tough,
182
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2992
ELAM 對課業要求很嚴格，
08:48
but 80 percent of its students graduate.
183
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但學生畢業率達 80%。
08:52
The subjects are familiar —
184
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1346
主修科目跟一般醫學院一樣：
08:53
basic and clinical sciences —
185
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2474
基礎科學與臨床科學。
08:56
but there are major differences.
186
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2426
但是也有很大的不同：
08:58
First, training has moved out of the ivory tower
187
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3611
首先，訓練走出了象牙塔，
09:02
and into clinic classrooms and neighborhoods,
188
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進入診間教室和社區，
09:05
the kinds of places most of these grads will practice.
189
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3364
就是多數畢業生將來執業的地方，
09:08
Sure, they have lectures and hospital rotations too,
190
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4094
當然他們也有講座和醫院輪班，
09:12
but community-based learning starts on day one.
191
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但是社區實習從新生入學就開始了。
09:17
Second, students treat the whole patient,
192
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3766
其次，學生注重全人治療，
09:21
mind and body,
193
549423
1914
兼顧病人的生理和心理，
09:23
in the context of their
families, their communities
families, their communities
194
551337
2506
並且考量病人的家庭、社群，
09:25
and their culture.
195
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2147
和文化背景。
09:27
Third, they learn public health:
196
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2900
第三，他們學習公共衛生，
09:30
to assess their patients' drinking water, housing,
197
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3100
評估病人的飲水、家居環境，
09:33
social and economic conditions.
198
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3296
和社經條件。
09:37
Fourth, they are taught
199
565286
2531
第四，他們學習到
09:39
that a good patient interview
200
567817
2767
仔細地問診
09:42
and a thorough clinical exam
201
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2104
加上周全的臨床檢測，
09:44
provide most of the clues for diagnosis,
202
572688
2835
可以深入了解病情，幫助診斷，
09:47
saving costly technology for confirmation.
203
575523
3903
省下確診技術的昂貴費用。
09:51
And finally, they're taught over and over again
204
579426
3550
最後，他們不斷被教育
09:54
the importance of prevention,
205
582976
2044
預防的重要性，
09:57
especially as chronic diseases
206
585020
2400
尤其是現在慢性疾病
09:59
cripple health systems worldwide.
207
587420
4160
拖垮世界各國的衛生醫療。
10:03
Such an in-service learning
208
591580
3190
這種實作學習
10:06
also comes with a team approach,
209
594770
2600
也注重團隊精神，
10:09
as much how to work in teams
210
597370
2867
學生們學習彼此合作，
10:12
as how to lead them,
211
600237
1946
也學習領導團隊，
10:14
with a dose of humility.
212
602183
2127
並且保持謙遜的態度。
10:16
Upon graduation, these doctors share
213
604310
2800
一畢業，這些新科醫生就開始
把知識分享給助理護士、助產士、
10:19
their knowledge with nurse's aids, midwives,
214
607110
2710
10:21
community health workers,
215
609820
1970
社區衛生工作者，
10:23
to help them become better at what they do,
216
611790
2386
幫助他們更能勝任工作，
10:26
not to replace them,
217
614176
1945
而不是取代他們，
10:28
to work with shamans and traditional healers.
218
616121
3129
也會跟巫醫和傳統治療工作者合作。
10:33
ELAM's graduates:
219
621311
2559
ELAM 的畢業生
10:35
Are they proving this audacious experiment right?
220
623870
4657
是否證明了這麼大膽的嘗試奏效？
10:40
Dozens of projects give us an inkling
221
628527
2295
從數十個計畫
可以窺知他們的能力。
10:42
of what they're capable of doing.
222
630822
2568
像是加利福納的畢業生，
10:45
Take the Garífuna grads.
223
633390
1763
10:47
They not only went to work back home,
224
635153
2190
不但回到家鄉工作，
10:49
but they organized their communities to build
225
637343
2407
還集結社區力量，
蓋了宏都拉斯第一間原住民醫院。
10:51
Honduras' first indigenous hospital.
226
639750
3401
10:55
With an architect's help,
227
643151
2149
在一位建築師的幫助下，
10:57
residents literally raised it from the ground up.
228
645300
4477
居民們胼手胝足，
憑空打造出一座醫院。
憑空打造出一座醫院。
11:01
The first patients walked through the doors
229
649777
2182
2007 年 12 月，收了首批病患
11:03
in December 2007,
230
651959
2340
11:06
and since then, the hospital has received
231
654299
2509
到現在，這間醫院收容過
11:08
nearly one million patient visits.
232
656808
3150
將近 100 萬的求診人次，
11:11
And government is paying attention,
233
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2161
而政府也很關注，
11:14
upholding the hospital as a model
234
662119
2521
以這所醫院做為宏都拉斯
農村公共醫療的模範，
11:16
of rural public health for Honduras.
235
664640
5179
11:21
ELAM's graduates are smart,
236
669819
3648
ELAM 的畢業生聰明、
11:25
strong and also dedicated.
237
673467
3453
堅強能幹，
而且全心奉獻。
11:28
Haiti, January 2010.
238
676920
4354
2010 年 1 月海地地震，
11:33
The pain.
239
681274
1835
傷慟的悲劇：
11:35
People buried under 30 million tons of rubble.
240
683109
4003
人們被埋在 3 千萬噸的瓦礫碎片下，
11:39
Overwhelming.
241
687112
2149
悲痛難當！
11:41
Three hundred forty Cuban doctors
242
689261
1878
340 個古巴醫生
已經長期駐地救治傷患。
11:43
were already on the ground long term.
243
691139
2441
還有很多醫生正在趕過來，
但仍需要更多的醫生。
但仍需要更多的醫生。
11:45
More were on their way. Many more were needed.
244
693580
2403
11:47
At ELAM, students worked round the clock
245
695983
3244
在 ELAM，學生們晝夜不停地
11:51
to contact 2,000 graduates.
246
699227
3218
聯繫 2 千位畢業醫生。
11:54
As a result, hundreds arrived in Haiti,
247
702445
3184
結果，好幾百位醫生趕來海地，
總共來自 27 個國家，
11:57
27 countries' worth, from Mali in the Sahara
248
705629
4297
包括撒哈拉的馬利、
聖露西亞、玻利維亞、
智利、美國等國家，
智利、美國等國家，
12:01
to St. Lucia, Bolivia, Chile and the USA.
249
709926
4488
12:06
They spoke easily to each other in Spanish
250
714414
3296
彼此用流利的西班牙語溝通，
12:09
and listened to their patients in Creole
251
717710
2689
也能了解病人用克里奧爾語描述病情，
12:12
thanks to Haitian medical students
252
720399
2126
幸好有這些海地學生，
從古巴 ELAM 醫學院及時飛過來。
12:14
flown in from ELAM in Cuba.
253
722525
2227
很多人待了好幾個月，
12:16
Many stayed for months,
254
724752
1688
12:18
even through the cholera epidemic.
255
726440
2778
甚至爆發霍亂疫情，仍堅守不離。
12:21
Hundreds of Haitian graduates
256
729218
2340
數百位海地的 ELAM 畢業生，
12:23
had to pick up the pieces,
257
731558
2722
必須收拾殘局重建家園，
12:26
overcome their own heartbreak,
258
734280
2014
忍住自己的傷慟，
12:28
and then pick up the burden
259
736294
1866
然後一肩扛起重擔，
為海地建立全新的公共衛生系統。
12:30
of building a new public health system for Haiti.
260
738160
3568
現在，有了世界組織和各國政府資助
12:33
Today, with aid of organizations and governments
261
741728
2497
12:36
from Norway to Cuba to Brazil,
262
744225
2553
包括挪威、古巴、巴西等國家，
12:38
dozens of new health centers have been built,
263
746778
2226
已經蓋好數十所新衛生中心，
12:41
staffed, and in 35 cases, headed
264
749004
3571
找好人手，
其中 35 所，院長是 ELAM 畢業生。
12:44
by ELAM graduates.
265
752575
3922
不過，海地事件
12:48
Yet the Haitian story
266
756497
1868
12:50
also illustrates some of the bigger problems
267
758365
2059
也暴露了很多國家面臨的更大問題。
12:52
faced in many countries.
268
760424
2216
我們來看一下：
12:54
Take a look:
269
762640
1744
12:56
748 Haitian graduates by
2012, when cholera struck,
2012, when cholera struck,
270
764384
5782
截至 2012 年爆發霍亂時，
共有 748 個海地畢業生，
共有 748 個海地畢業生，
13:02
nearly half working in the public health sector
271
770166
3746
其中近半數在公共衛生單位工作，
13:05
but one quarter unemployed,
272
773912
2071
但是有 1/4 失業，
13:07
and 110 had left Haiti altogether.
273
775983
6110
還有 110 人被迫出國找工作。
13:14
So in the best case scenarios,
274
782093
2768
最理想的情況是，
13:16
these graduates are staffing
275
784861
1870
這些畢業生都能順利就業，
13:18
and thus strengthening public health systems,
276
786731
3249
強化公共衛生體系，
13:21
where often they're the only doctors around.
277
789980
3179
到從未有過醫生的地方開業。
13:25
In the worst cases, there are simply not enough jobs
278
793159
2791
最壞的情況，
公共衛生體系根本沒有足夠的職缺，
13:27
in the public health sector,
279
795950
1642
而這些通常是窮人看病的地方；
13:29
where most poor people are treated,
280
797592
2566
13:32
not enough political will, not enough resources,
281
800158
2799
政治決心不夠、
資源不夠、
13:34
not enough anything —
282
802957
2206
什麼東西都不夠，
13:37
just too many patients with no care.
283
805163
3453
只有太多缺乏醫療照護的病人。
13:40
The grads face pressure from their families too,
284
808616
2984
ELAM 畢業生也有家庭壓力，
13:43
desperate to make ends meet,
285
811600
2303
急需餵飽一家子。
13:45
so when there are no public sector jobs,
286
813903
2576
所以如果公共衛生單位沒有職缺，
13:48
these new MDs decamp into private practice,
287
816479
2621
這些新手醫生轉到私人醫院，
13:51
or go abroad to send money home.
288
819100
4015
有些人只好出國工作，
寄錢回家。
13:55
Worst of all, in some countries,
289
823115
3185
最糟糕的是，
有些國家，
13:58
medical societies influence accreditation bodies
290
826300
2936
醫學界會左右認證機關，
14:01
not to honor the ELAM degree,
291
829236
3015
不讓其承認 ELAM 的學歷，
14:04
fearful these grads will take their jobs
292
832251
2317
因為怕 ELAM 畢業生搶飯碗，
14:06
or reduce their patient loads and income.
293
834568
3555
或是搶走病人，害他們收入減少。
14:10
It's not a question of competencies.
294
838123
2981
這非關能力問題。
14:13
Here in the USA, the California Medical Board
295
841104
2508
在美國，加州醫學委員會
14:15
accredited the school after rigorous inspection,
296
843612
3600
經過嚴密審查後才認證這間學校，
14:19
and the new physicians are making good
297
847212
2048
這些 ELAM 畢業生表現優異，
14:21
on Cuba's big bet,
298
849260
2191
不負醫學院的期望，
14:23
passing their boards and accepted
299
851451
1811
他們通過醫師資格考試，
14:25
into highly respected residencies
300
853262
2385
進入信譽卓著的醫院擔任住院醫師，
14:27
from New York to Chicago to New Mexico.
301
855647
4091
從紐約、芝加哥到新墨西哥都有。
14:31
Two hundred strong, they're coming
302
859738
2625
兩百名 ELAM 精兵回到美國，
14:34
back to the United States energized,
303
862363
2385
滿腔熱忱，
14:36
and also dissatisfied.
304
864748
2587
但也非常不滿。
14:39
As one grad put it,
305
867335
1631
有一個畢業生說：
14:40
in Cuba, "We are trained to provide quality care
306
868966
3454
「在古巴，我們學到
用最少的資源，提供最高品質的醫護，
14:44
with minimal resources,
307
872420
2002
14:46
so when I see all the resources we have here,
308
874422
2576
所以當我看見美國醫院資源這麼多，
14:48
and you tell me that's not possible,
309
876998
2162
你們卻說做不到，
14:51
I know it's not true.
310
879160
2170
我知道事實不是這樣。
14:53
Not only have I seen it work, I've done the work."
311
881330
5619
我不止看過其他人辦到，
我還親自做到了！」
14:58
ELAM's graduates,
312
886949
1961
ELAM 的畢業生，
15:00
some from right here in D.C. and Baltimore,
313
888910
3517
有些正是來自
華盛頓特區及巴爾的摩這裡，
華盛頓特區及巴爾的摩這裡，
15:04
have come from the poorest of the poor
314
892427
3168
是窮人裡的最窮，
15:07
to offer health, education
315
895595
2333
他們想提供醫療服務、教育，
15:09
and a voice to their communities.
316
897928
2916
並為社區發聲。
15:12
They've done the heavy lifting.
317
900844
2652
他們突破萬難扛起重任，
15:15
Now we need to do our part
318
903496
2014
現在輪到我們盡一份心力，
15:17
to support the 23,000 and counting,
319
905510
3617
支持這 2 萬 3 千位年輕人，
人數還在增加。
我們所有的人—
15:21
All of us —
320
909127
1354
15:22
foundations, residency directors, press,
321
910481
3634
基金會、住院醫師訓練負責人、媒體、
15:26
entrepreneurs, policymakers, people —
322
914115
3184
企業家、決策者和人民，
15:29
need to step up.
323
917299
2153
都必須挺身而出。
15:31
We need to do much more globally
324
919452
1991
全世界都必須做得更多，
15:33
to give these new doctors the opportunity
325
921443
2939
給這些新科醫生機會，
15:36
to prove their mettle.
326
924382
2393
證明自己的堅毅；
15:38
They need to be able
327
926775
1003
他們必須能夠
15:39
to take their countries' licensing exams.
328
927778
3204
參加自己國家的證照考試，
15:42
They need jobs in the public health sector
329
930982
2948
他們需要工作機會，
服務於公共衛生單位，
15:45
or in nonprofit health centers
330
933930
1755
或是非營利衛生中心，
15:47
to put their training and commitment to work.
331
935685
3847
貢獻所學和決心。
15:51
They need the chance to be
332
939532
2283
他們需要機會
15:53
the doctors their patients need.
333
941815
4859
成為病人最需要的醫生。
15:58
To move forward,
334
946674
1857
要邁向未來，
16:00
we may have to find our way back
335
948531
2992
我們可能必須先回到過去，
16:03
to that pediatrician who would
336
951523
2183
回到小時候那個熱心的小兒科醫師，
16:05
knock on my family's door
337
953706
1687
會來芝加哥南區敲我家的門，
16:07
on the South Side of Chicago when I was a kid,
338
955393
3186
16:10
who made house calls,
339
958579
1910
會四處出診，探訪病人，
16:12
who was a public servant.
340
960489
2891
真正的服務人群。
16:15
These aren't such new ideas
341
963380
1823
這些都不是醫學定位的新觀念，
16:17
of what medicine should be.
342
965203
2362
16:19
What's new is the scaling up
343
967565
2725
不同的只是把範圍擴大，
16:22
and the faces of the doctors themselves:
344
970290
3383
和這些生力軍的新面孔。
16:25
an ELAM graduate is more likely to be a she
345
973673
3457
ELAM 畢業生裡，
女性比例較高，
16:29
than a he;
346
977130
1930
多於男性。
16:31
In the Amazon, Peru or Guatemala,
347
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2927
在亞馬遜、秘魯或瓜地馬拉，
16:33
an indigenous doctor;
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醫生很可能是原住民；
16:36
in the USA, a doctor of color
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在美國，
醫生可能不是白人，
而且會說流利的西班牙語。
16:39
who speaks fluent Spanish.
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16:41
She is well trained, can be counted on,
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她們受過良好的訓練，
為人處事可靠，
來自跟病人相同的種族與文化，
16:45
and shares the face and culture of her patients,
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16:49
and she deserves our support surely,
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確實值得我們支持。
16:52
because whether by subway, mule, or canoe,
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因為不論是坐地鐵、騾子或獨木舟，
16:56
she is teaching us to walk the walk.
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她們都在啟發我們付諸行動。
謝謝！（觀眾掌聲）
16:59
Thank you. (Applause)
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ABOUT THE SPEAKER
Gail Reed - Cuban health care expertAmerican journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own.
Why you should listen
Many of the doctors treating ebola patients in Africa were trained in Cuba. Why? In this informative talk, journalist Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries -- if they pledge to serve the communities who need them most.
More profile about the speakerGail Reed | Speaker | TED.com